scholarly journals ICU delirium burden predicts functional neurologic outcomes

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0259840
Author(s):  
Luis Paixao ◽  
Haoqi Sun ◽  
Jacob Hogan ◽  
Katie Hartnack ◽  
Mike Westmeijer ◽  
...  
Keyword(s):  
Critical Illness ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Neurologic Outcome ◽  
Post Discharge ◽  
Mechanically Ventilated ◽  
Neurological Outcomes ◽  
Survival Status ◽  
Neurologic Outcomes ◽  
Icu Delirium

Background We investigated the effect of delirium burden in mechanically ventilated patients, beginning in the ICU and continuing throughout hospitalization, on functional neurologic outcomes up to 2.5 years following critical illness. Methods Prospective cohort study of enrolling 178 consecutive mechanically ventilated adult medical and surgical ICU patients between October 2013 and May 2016. Altogether, patients were assessed daily for delirium 2941days using the Confusion Assessment Method for the ICU (CAM-ICU). Hospitalization delirium burden (DB) was quantified as number of hospital days with delirium divided by total days at risk. Survival status up to 2.5 years and neurologic outcomes using the Glasgow Outcome Scale were recorded at discharge 3, 6, and 12 months post-discharge. Results Of 178 patients, 19 (10.7%) were excluded from outcome analyses due to persistent coma. Among the remaining 159, 123 (77.4%) experienced delirium. DB was independently associated with >4-fold increased mortality at 2.5 years following ICU admission (adjusted hazard ratio [aHR], 4.77; 95% CI, 2.10–10.83; P < .001), and worse neurologic outcome at discharge (adjusted odds ratio [aOR], 0.02; 0.01–0.09; P < .001), 3 (aOR, 0.11; 0.04–0.31; P < .001), 6 (aOR, 0.10; 0.04–0.29; P < .001), and 12 months (aOR, 0.19; 0.07–0.52; P = .001). DB in the ICU alone was not associated with mortality (HR, 1.79; 0.93–3.44; P = .082) and predicted neurologic outcome less strongly than entire hospital stay DB. Similarly, the number of delirium days in the ICU and for whole hospitalization were not associated with mortality (HR, 1.00; 0.93–1.08; P = .917 and HR, 0.98; 0.94–1.03, P = .535) nor with neurological outcomes, except for the association between ICU delirium days and neurological outcome at discharge (OR, 0.90; 0.81–0.99, P = .038). Conclusions Delirium burden throughout hospitalization independently predicts long term neurologic outcomes and death up to 2.5 years after critical illness, and is more predictive than delirium burden in the ICU alone and number of delirium days.

scholarly journals Insulin-like growth factor-1 and delirium in critically ill mechanically ventilated patients: a preliminary investigation

2011 ◽  
Vol 23 (7) ◽  
pp. 1175-1181 ◽  
Author(s):  
A. Morandi ◽  
M. L. Gunther ◽  
P. P. Pandharipande ◽  
J. C. Jackson ◽  
J. L. Thompson ◽  
...  
Keyword(s):  
Critical Illness ◽  
Growth Factor ◽  
Critically Ill ◽  
Mental State ◽  
Preliminary Investigation ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Insulin Like Growth Factor ◽  
Mechanically Ventilated ◽  
Serial Measurements

ABSTRACTBackground: Delirium occurs frequently in the intensive care unit (ICU), but its pathophysiology is still unclear. Low levels of insulin-like growth factor 1 (IGF-1), a hormone with neuroprotective properties, have been associated with delirium in some non-ICU studies, but this relationship has not been examined in the ICU. We sought to test the hypothesis that low IGF-1 concentrations are associated with delirium during critical illness.Methods: Mechanically ventilated medical ICU patients were prospectively enrolled, and blood was collected after enrollment for measurement of IGF-1 using radioimmunometric assay. Delirium and coma were identified daily using the Confusion Assessment Method for the ICU and the Richmond Agitation-Sedation Scale, respectively. The association between IGF-1 and delirium was evaluated with logistic regression. In addition, the association between IGF-1 and duration of normal mental state, measured as days alive without delirium or coma, was assessed using multiple linear regression.Results: Among 110 patients, the median age was 65 years (IQR, 52–75) and APACHE II was 27 (IQR, 22 –32). IGF-1 levels were not a risk factor for delirium on the day after IGF-1 measurement (p = 0.97), at which time 65% of the assessable patients were delirious. No significant association was found between IGF-1 levels and duration of normal mental state (p = 0.23).Conclusions: This pilot study, the first to investigate IGF-1 and delirium in critically ill patients, found no association between IGF-1 and delirium. Future studies including serial measurements of IGF-1 and IGF-1 binding proteins are needed to determine whether this hormone has a role in delirium during critical illness.

scholarly journals Advanced Age Is Associated With Catatonia in Critical Illness: Results From the Delirium and Catatonia Prospective Cohort Investigation

2021 ◽  
Vol 12 ◽  
Author(s):  
Jennifer Connell ◽  
Ahra Kim ◽  
Nathan E. Brummel ◽  
Mayur B. Patel ◽  
Simon N. Vandekar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Rating Scale ◽  
Medical Center ◽  
Adult Population ◽  
Academic Medical Center ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Advanced Age

Introduction: Catatonia, characterized by motor, behavioral and affective abnormalities, frequently co-occurs with delirium during critical illness. Advanced age is a known risk factor for development of delirium. However, the association between age and catatonia has not been described. We aim to describe the occurrence of catatonia, delirium, and coma by age group in a critically ill, adult population.Design: Convenience cohort, nested within two clinical trials and two observational cohort studies.Setting: Intensive care units in an academic medical center in Nashville, TN.Patients: 378 critically ill adult patients on mechanical ventilation and/or vasopressors.Measurements and Main Results: Patients were assessed for catatonia, delirium, and coma by independent and blinded personnel, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method for the Intensive Care Unit (ICU) and the Richmond Agitation and Sedation Scale. Of 378 patients, 23% met diagnostic criteria for catatonia, 66% experienced delirium, and 52% experienced coma during the period of observation. There was no relationship found between age and catatonia severity or age and presence of specific catatonia items. The prevalence of catatonia was strongly associated with age in the setting of critical illness (p &lt; 0.05). Delirium and comas' association with age was limited to the setting of catatonia.Conclusion: Given the significant relationship between age and catatonia independent of coma and delirium status, these data demonstrate catatonia's association with advanced age in the setting of critical illness. Future studies can explore the causative factors for this association and further elucidate the risk factors for acute brain dysfunction across the age spectrum.

scholarly journals E.04 Coma and delirium are associated with low levels of brain tissue oxygen in critically ill patients

2016 ◽  
Vol 43 (S2) ◽  
pp. S17-S17
Author(s):  
MD Wood ◽  
D Maslove ◽  
J Muscedere ◽  
JG Boyd
Keyword(s):  
Brain Tissue ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Near Infrared ◽  
Neurological Status ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Brain Tissue Oxygenation ◽  
Low Levels ◽  
Icu Delirium

Background: The cause of ICU delirium is unknown. We used near infrared spectroscopy (NIRS) to measure brain tissue oxygenation (BtO2) in critically ill patients, to test the hypothesis that poor cerebral oxygen delivery contributes to ICU delirium. Methods: Adult patients were enrolled if they required mechanical ventilation for >24 hours, and/or vasoactive agents. Patients were excluded if they had previous cognitive dysfunction, brain injury on admission, or a life expectancy <24 hours. BtO2 was measured for the first 24 hours of ICU admission. The confusion assessment method-ICU (CAM-ICU) was used to screen for delirium. Participants were designated to one of three groups on the basis of their predominant neurological status (comatose, delirious, or intact). Results: To date, 47 patients have been recruited. Both delirious and comatose patients’ had significantly lower BtO2 levels compared to intact patients (P<0.001). There was a significant correlation between hemoglobin and BtO2 (R2=0.347, P<0.01). However, when correlation analysis was conducted separately amongst the three groups, the delirious patients (R2=0.485, P<0.05) were the strongest contributors to this positive correlation. Conclusions: Delirious patients exhibited the lowest BtO2 recordings and demonstrated a significant association between Hb and BtO2. This study offers potential insight into the pathophysiology of ICU delirium.

Agitation

2018 ◽  
pp. 180-183
Author(s):  
Megan Rashid
Keyword(s):  
Correct Diagnosis ◽  
Altered Mental Status ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Early Mobility ◽  
Confusion Assessment ◽  
Life Threatening ◽  
High Risk Populations ◽  
Icu Delirium ◽  
Abcdef Bundle

The case illustrates a classic example of intensive care unit (ICU) delirium, which often goes unrecognized but can adversely affect both morbidity and mortality. The Confusion Assessment Method for the ICU (CAM-ICU) is a validated tool for diagnosing delirium, but it remains a diagnosis of exclusion, and it is important to rule out potentially life-threatening medical causes of altered mental status. Treatment is difficult even with the correct diagnosis, and prevention is key. The ABCDEF bundle (assessing and managing pain, both SAT and SBT, choice of analgesia/sedation, delirium, early mobility, and family engagement) is a tool that identifies high-risk populations, and can help mitigate the prevalence of ICU delirium.

Using Telehealth to Improve the Accuracy of Delirium Screening by Bedside Critical Care Nurses

2022 ◽  
Vol 31 (1) ◽  
pp. 73-76
Author(s):  
Liron Sinvani ◽  
Craig Hertz ◽  
Saurabh Chandra ◽  
Anum Ilyas ◽  
Suzanne Ardito ◽  
...  
Keyword(s):  
Management Training ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Patient Centered ◽  
Inappropriate Use ◽  
Spot Check ◽  
Delirium Management ◽  
The Mean ◽  
Icu Delirium ◽  
Knowledge Deficits

Background Delirium affects up to 80% of patients in the intensive care unit (ICU) but is missed in up to 75% of cases. Telehealth in the ICU (tele-ICU) has become the standard for providing timely, expert care to remotely located ICUs. Objectives This pilot study assessed the feasibility and acceptability of using tele-ICU to increase the accuracy of delirium screening and recognition by ICU nurses. Methods The pilot sites included 4 ICUs across 3 hospitals. A geriatrician with delirium expertise remotely observed 13 bedside ICU nurses administering the Confusion Assessment Method for the ICU (CAM-ICU) to patients in real time via the tele-ICU platform and subsequently provided training on CAM-ICU performance and delirium management. Training evaluation consisted of a validated spot check form, a 2-item satisfaction/change-of-practice survey, and a qualitative question on acceptability. Results Thirteen ICU nurses were observed performing 26 bedside delirium assessments. The top observed barriers to accurate delirium screening were CAM-ICU knowledge deficits, establishment of baseline cognition, and inappropriate use of the “unable to assess” designation. The mean percentage of correct observations improved from 40% (first observation) to 90% (second observation) (P &lt; .001). All 13 nurses strongly agreed that the training was beneficial and practice changing. Conclusions The use of tele-ICU to improve the accuracy of delirium screening by ICU nurses appears to be feasible and efficient for leveraging delirium expertise across multiple ICUs. Future studies should evaluate the effects of tele-ICU delirium training on patient-centered outcomes.

scholarly journals Automated tracking of level of consciousness and delirium in critical illness using deep learning

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Haoqi Sun ◽  
Eyal Kimchi ◽  
Oluwaseun Akeju ◽  
Sunil B. Nagaraj ◽  
Lauren M. McClain ◽  
...  
Keyword(s):  
Deep Learning ◽  
Critical Illness ◽  
Elective Surgery ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Eeg Signals ◽  
Automated Tracking ◽  
Level Of Consciousness ◽  
Behavioral Assessments ◽  
Deep Learning Model

Abstract Over- and under-sedation are common in the ICU, and contribute to poor ICU outcomes including delirium. Behavioral assessments, such as Richmond Agitation-Sedation Scale (RASS) for monitoring levels of sedation and Confusion Assessment Method for the ICU (CAM-ICU) for detecting signs of delirium, are often used. As an alternative, brain monitoring with electroencephalography (EEG) has been proposed in the operating room, but is challenging to implement in ICU due to the differences between critical illness and elective surgery, as well as the duration of sedation. Here we present a deep learning model based on a combination of convolutional and recurrent neural networks that automatically tracks both the level of consciousness and delirium using frontal EEG signals in the ICU. For level of consciousness, the system achieves a median accuracy of 70% when allowing prediction to be within one RASS level difference across all patients, which is comparable or higher than the median technician–nurse agreement at 59%. For delirium, the system achieves an AUC of 0.80 with 69% sensitivity and 83% specificity at the optimal operating point. The results show it is feasible to continuously track level of consciousness and delirium in the ICU.

scholarly journals Predicting Hospital Mortality and Length of Stay: The Delirium Screening Checklist versus Confusion Assessment Method for Intensive Care Units

2021 ◽  
Author(s):  
Hsiu Ching Li ◽  
Cheryl Chia-Hui Chen ◽  
Tony Yu-Chang Yeh ◽  
Shih-Cheng Liao ◽  
Adrian-Shengchun Hsu ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Predictive Validity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Confusion Assessment ◽  
Icu Delirium

Abstract Background: Both the intensive care delirium screening checklist (ICDSC) and confusion assessment method for ICU (CAM-ICU) are valid tools for identification of delirium, however their relative predictive validity for important delirium outcomes, such as hospital mortality and LOS have not been well-established. We aim to compare the two tools for their predictive validity for outcomes related to delirium, hospital mortality and length of stay (LOS).Methods: The prospective cohort study conducted in six medical ICUs at a tertiary care hospital in Taiwan. The study enrolled consecutive adult patients (≥20 years) who were delirium free at ICU admission. Delirium was screened daily by trained research nurses using the ICDSC and CAM-ICU in random order. Arousal was assessed by the Richmond Agitation-Sedation Scale (RASS). Participants with any one positive result were classified as ICDSC- or CAM-ICU-delirium groups, respectively.Results: Delirium incidence evaluated by the ICDSC and CAM-ICU were 69.1% (67/97) and 50.5% (49/97), respectively. Although the ICDSC identified 18 more cases as delirious, substantial concordance (κ =0.63; p < 0.001) was found between tools. Independent of age, APACHE II score, and Charlson comorbidity index, both ICDSC- and CAM-ICU-rated delirium significantly predicted hospital mortality (adjusted odds ratio [aOR] 4.93; 95% confidence interval [CI]:1.56 to 15.63 vs. 2.79; 95% CI, 1.12 to 6.97, respectively), and only the ICDSC significantly predicted hospital LOS with a mean of 17.59 additional days compared to the no-delirium group. Irrespective of delirium status, a sensitivity analysis of normal-to-increased arousal (RASS≥0) test results did not alter the predictive ability of ICDSC- or CAM-ICU-delirium for hospital mortality (aOR 2.97; 95% CI, 1.06 to 8.37 vs. 3.82; 95% CI, 1.35 to 10.82, respectively). With reduced arousal (RASS<0), neither tool significantly predicted mortality or LOS.Conclusions: The ICDSC identified more delirium cases and may have higher predictive validity for mortality and LOS than the CAM-ICU. However, arousal substantially affected performance. Future studies may want to consider patients’ arousal when deciding which tool to use to maximize the effects of delirium identification on patient mortality.Trial registration: NCT 04206306

scholarly journals Serum melatonin concentration in critically ill patients randomized to sedation or non-sedation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jakob Oxlund ◽  
Torben Knudsen ◽  
Thomas Strøm ◽  
Jørgen T. Lauridsen ◽  
Poul J. Jennum ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Secondary Outcome ◽  
Melatonin Level ◽  
Melatonin Concentration ◽  
Mechanically Ventilated

Abstract Background Abolished circadian rhythm is associated with altered cognitive function, delirium, and as a result increased mortality in critically ill patients, especially in those who are mechanically ventilated. The causes are multifactorial, of which changes in circadian rhythmicity may play a role. Melatonin plays a crucial role as part of the circadian and sleep/wake cycle. Whether sedation effects circadian regulation is unknown. Hence, the objective of this study was to evaluate the melatonin concentration in critically ill patients randomized to sedation or non-sedation and to investigate the correlation with delirium. Methods All patients were included and randomized at the intensive care unit at the hospital of southwest Jutland, Denmark. Seventy-nine patients completed the study (41 sedated and 38 non-sedated). S-melatonin was measured 3 times per day, (03.00, 14.00, and 22.00), for 4 consecutive days in total, starting on the second day upon randomization/intubation. The study was conducted as a sub-study to the NON-SEDA study in which one hundred consecutive patients were randomized to sedation or non-sedation with a daily wake-up call (50 in each arm). Primary outcome: melatonin concentration in sedated vs. non-sedated patients (analyzed using linear regression). Secondary outcome: risk of developing delirium or non-medically induced (NMI) coma in sedated vs. non-sedated patients, assessed by CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) analyzed using logistic regression. Results Melatonin concentration was suppressed in sedated patients compared to the non-sedated. All patients experienced an elevated peak melatonin level early on in the course of their critical illness (p = 0.01). The risk of delirium or coma (NMI) was significantly lower in the non-sedated group (OR 0.42 CI 0.27; 0.66 p < 0.0001). No significant relationship between delirium development and suppressed melatonin concentration was established in this study (OR 1.004 p = 0.29 95% CI 0.997; 1.010). Conclusion Melatonin concentration was suppressed in sedated, critically ill patients, when compared to non-sedated controls and the frequency of delirium was elevated in sedated patients. Trail registration Clinicaltrials.gov (NCT01967680) on October 23, 2013.

scholarly journals Incidence and factors related to delirium in an intensive care unit

2016 ◽  
Vol 50 (4) ◽  
pp. 587-593 ◽  
Author(s):  
Satomi Mori ◽  
Juliana Rumy Tsuchihashi Takeda ◽  
Fernanda Souza Angotti Carrara ◽  
Cibelli Rizzo Cohrs ◽  
Suely Sueko Viski Zanei ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Univariate Analysis ◽  
Severity Of Illness ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
University Hospital ◽  
Icu Stay ◽  
High Incidence ◽  
Icu Delirium

Abstract OBJECTIVES To identify the incidence of delirium, compare the demographic and clinical characteristics of patients with and without delirium, and verify factors related to delirium in critical care patients. METHOD Prospective cohort with a sample made up of patients hospitalized in the Intensive Care Unit (ICU) of a university hospital. Demographic, clinical variables and evaluation with the Confusion Assessment Method for Intensive Care Unit to identify delirium were processed to the univariate analysis and logistic regression to identify factors related to the occurrence of delirium. RESULTS Of the total 149 patients in the sample, 69 (46.3%) presented delirium during ICU stay, whose mean age, severity of illness and length of ICU stay were statistically higher. The factors related to delirium were: age, midazolam, morphine and propofol. CONCLUSION Results showed high incidence of ICU delirium associated with older age, use of sedatives and analgesics, emphasizing the need for relevant nursing care to prevent and identify early, patients presenting these characteristics.

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